Anthem Blue Cross and Blue Shield Nevada prior authorization, page 46
CPT code lookup
Each row is one code from the public prior authorization list. The description is the procedure or service name on that source row. This is not a coverage decision.
Prior authorization codes
| Code | Description | Source |
|---|---|---|
| 89330 | Sperm Evaluation; Cervical Mucus Penetration Test, W/Wo Spinnbarkeit Test | Nevada Prior Authorization List, Pg 100 Original policy |
| 89337 | Cryopreservation, mature oocyte(s) | Nevada Prior Authorization List, Pg 100 Original policy |
| 89344 | Storage, (Per Year); Reproductive Tissue, Testicular/Ovarian | Nevada Prior Authorization List, Pg 100 Original policy |
| 89346 | Storage, (Per Year); Oocyte | Nevada Prior Authorization List, Pg 100 Original policy |
| 89354 | Thawing of Cryopreserved; Reproductive Tissue, Testicular/Ovarian | Nevada Prior Authorization List, Pg 100 Original policy |
| 89356 | Thawing of Cryopreserved; Oocytes, Each Aliquot | Nevada Prior Authorization List, Pg 100 Original policy |
| 90281 | Immune Globulin (Ig), Human, Im Use | Nevada Prior Authorization List, Pg 100 Original policy |
| 90283 | Immune Globulin (Igiv), Human, Iv Use | Nevada Prior Authorization List, Pg 100 Original policy |
| 90284 | Immune globulin (SCIg), human, for use in subcutaneous infusions, 100mg, each | Nevada Prior Authorization List, Pg 100 Original policy |
| 90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each | Nevada Prior Authorization List, Pg 100 Original policy |
| 90380 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use | Nevada Prior Authorization List, Pg 100 Original policy |
| 90381 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use | Nevada Prior Authorization List, Pg 100 Original policy |
| 90382 | Respiratory syncytial virus, monoclonal antibody, seasonal dose, 0.7 mL, for intramuscular use | Nevada Prior Authorization List, Pg 100 Original policy |
| 90867 | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management | Nevada Prior Authorization List, Pg 100 Original policy |
| 90868 | Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session | Nevada Prior Authorization List, Pg 100 Original policy |
| 90869 | Therapeutic Repetitive Transcranial Magnetic Stimulation (Tms) Treatment; Subsequent Motor Threshold Re-Determination With Delivery And Management | Nevada Prior Authorization List, Pg 100 Original policy |
| 90875 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Nevada Prior Authorization List, Pg 100 Original policy |
| 90876 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Nevada Prior Authorization List, Pg 100 Original policy |
| 90901 | Biofeedback Training, Any Modality | Nevada Prior Authorization List, Pg 100 Original policy |
| 90912 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one- on-one physician or other qu | Nevada Prior Authorization List, Pg 101 Original policy |
| 90913 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or | Nevada Prior Authorization List, Pg 101 Original policy |
| 91112 | Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report | Nevada Prior Authorization List, Pg 101 Original policy |
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual | Nevada Prior Authorization List, Pg 101 Original policy |
| 92508 | Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals | Nevada Prior Authorization List, Pg 101 Original policy |
| 92521 | Evaluation of speech fluency (eg, stuttering, cluttering) | Nevada Prior Authorization List, Pg 101 Original policy |
| 92522 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria) | Nevada Prior Authorization List, Pg 101 Original policy |
| 92523 | Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive an | Nevada Prior Authorization List, Pg 101 Original policy |
| 92524 | Behavioral and qualitative analysis of voice and resonance | Nevada Prior Authorization List, Pg 101 Original policy |
| 92526 | Treatment, Swallowing Dysfunction &/Or Oral Function, Feeding | Nevada Prior Authorization List, Pg 101 Original policy |
| 92605 | Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour | Nevada Prior Authorization List, Pg 101 Original policy |
| 92606 | Therapeutic Service(S), Use Non-Speech Generatiing Device, W/Programming & Modification | Nevada Prior Authorization List, Pg 101 Original policy |
| 92607 | Eval, Prescription, Speech-Generating Augmentative & Alternative Communication Device; 1st Hr | Nevada Prior Authorization List, Pg 101 Original policy |
| 92608 | Eval, Prescrip, Speech-Generating Augmentative & Alternative Communication Device; Ea Add'l 30 Min | Nevada Prior Authorization List, Pg 101 Original policy |
| 92609 | Therapeutic Services, Non-Speech Generative Device Use, W/Programming & Modification | Nevada Prior Authorization List, Pg 101 Original policy |
| 92610 | Eval, Oral & Pharyngeal Swallow Function | Nevada Prior Authorization List, Pg 101 Original policy |
| 92611 | Motion Fluoroscopic Eval, Swallow Function, Cine/Video Record | Nevada Prior Authorization List, Pg 101 Original policy |
| 92618 | Evaluation For Prescription Of Non-Speech-Generating Augmentative And Alternative Communication Device, Face-To-Face With The Patient; Each Additional 30 Minutes (List Separat | Nevada Prior Authorization List, Pg 101 Original policy |
| 92626 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour | Nevada Prior Authorization List, Pg 101 Original policy |
| 92627 | Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (List sepa | Nevada Prior Authorization List, Pg 101 Original policy |
| 92630 | Auditory rehabilitation; pre-lingual hearing loss | Nevada Prior Authorization List, Pg 102 Original policy |
| 92633 | Auditory rehabilitation; post-lingual hearing loss | Nevada Prior Authorization List, Pg 102 Original policy |
| 92920 | Percutaneous transluminal coronary angioplasty, single major coronary artery and/or its branch(es) | Nevada Prior Authorization List, Pg 102 Original policy |
| 92924 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed, single major coronary artery and/or its branch(es) | Nevada Prior Authorization List, Pg 102 Original policy |
| 92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 1 lesion involvin | Nevada Prior Authorization List, Pg 102 Original policy |
| 92933 | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed, single major coronary artery and/or its branch(es) | Nevada Prior Authorization List, Pg 102 Original policy |
| 92937 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, ather | Nevada Prior Authorization List, Pg 102 Original policy |
| 92943 | Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major | Nevada Prior Authorization List, Pg 102 Original policy |
| 92972 | Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) | Nevada Prior Authorization List, Pg 102 Original policy |
| 93150 | Therapy activation of implanted phrenic nerve stimulator system, including all interrogation and programming | Nevada Prior Authorization List, Pg 102 Original policy |
| 93151 | Interrogation and programming (minimum one parameter) of implanted phrenic nerve stimulator system | Nevada Prior Authorization List, Pg 102 Original policy |